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PubMed1984

Peritonitis with continuous ambulatory peritoneal dialysis and continuous cycling peritoneal dialysis.

The frequency and cause of peritonitis in 18 children receiving continuous ambulatory peritoneal dialysis (CAPD) and nine children receiving continuous cycling peritoneal dialysis (CCPD) are described. Cumulative CAPD and CCPD experience demonstrated 58 episodes of peritonitis in 294 patient treatment months (one case per 5.1 patient treatment months). Total hospitalization for the treatment of peritonitis was 0.18 days per patient treatment month. Life table analysis revealed no significant difference in the peritonitis-free "survival" between the two modalities. Gram-negative organisms accounted for a significantly increased percentage of the peritonitis in CAPD compared with CCPD (65% vs 17%) (P less than 0.001). Thirty-seven percent of the gram-negative infections in the CAPD population were in children with nephrostomies. Factors predisposing to peritonitis were identified in 76% of cases occurring with CAPD. Peritonitis remains the major contributor to the morbidity associated with peritoneal dialysis, regardless of the technique. The resultant frequency of hospitalization is not prohibitive. Attention to the "high-risk" pediatric patient and education directed at several well-recognized predisposing factors may yield improved results.

Acinetobacter Infections↗

PubMed1995

IL-4 mRNA expression by peritoneal cells during episodes of peritonitis in patients on continuous ambulatory peritoneal dialysis.

Peritoneal cells were isolated from dialysates drained from nine patients on continuous ambulatory peritoneal dialysis (CAPD) during episodes of peritonitis. Levels of expression of mRNA for the regulatory cytokines, interferon-gamma (IFN-gamma) and IL-4, were investigated daily, where possible, during the first 5 days of peritonitis. Cytokine mRNA levels were compared with those of peripheral blood mononuclear cells (PBMC) stimulated in vitro with phorbol 12-myristate 13-acetate (PMA) plus phytohaemagglutinin (PHA). Peritoneal cells expressed low levels of IFN-gamma mRNA; for four of nine patients, IL-4 mRNA levels greater than those expressed by stimulated PBMC were detected. There was no pattern of cytokine mRNA expression associated with the types of organisms detected in dialysates at initiation of peritonitis. However, in contrast to those patients with a transient, resolving peritonitis, significant IL-4 mRNA expression was detected in cells isolated early in the episodes of peritonitis in patients who suffered recurrent peritonitis within 30 days of the initial peritonitis episode. These results suggest an association between early IL-4 mRNA expression and susceptibility to further infections. The known anti-inflammatory effects of IL-4 may explain this association.

Adult↗

PubMed1989

The time course of peritoneal transport kinetics in continuous ambulatory peritoneal dialysis patients who develop sclerosing peritonitis.

The time course of measurements of peritoneal solute transport in four continuous ambulatory peritoneal dialysis (CAPD) patients who developed sclerosing peritonitis is described. Loss of fluid removal capacity was found in all of them. In three, this loss was associated with an increase in peritoneal absorption of glucose from the dialysate and an increase in the transperitoneal transport rates of low-molecular-weight solutes and proteins. In the other patient a decrease in all these parameters was found. This seems to imply that the effective peritoneal surface area was increased in three patients and decreased in one. Peritoneal permeability to macromolecules remained unchanged as judged by the ratio between the clearance of IgG and albumin. Among the possible factors that contribute to the development of sclerosing peritonitis, some are likely to lead to a larger effective peritoneal surface area, like prostacyclin and the formation of new capillaries in poorly vascularized parts of the peritoneum. Others, such as extensive formation of collagen, could lead to a smaller effective surface area. Individual differences in susceptibility to these factors may lead to an increase or decrease in peritoneal solute transport rates. Follow-up measurements of peritoneal solute kinetics are necessary to identify those patients who are at risk.

Adult↗

PubMed2001

Peritoneal sclerosis in peritoneal dialysis patients related to dialysis settings and peritoneal transport properties.

BACKGROUND: Peritoneal sclerosis is a histopathologic finding that is probably causative of long-term system failure in peritoneal dialysis (PD). It may be due to uremic toxicity and the influence of peritoneal dialysate components. We intended to clarify to which degree peritoneal fibrosis and vascular changes were associated with the modalities of PD and the peritoneal transport characteristics. METHODS: Peritoneal biopsies of 41 patients suffering from end-stage renal disease were examined. Sixteen patients were at the initiation of dialysis treatment, and 25 patients were studied during chronic PD treatment [9 patients on continuous ambulatory PD (CAPD) and 16 patients on automatic PD (APD)]. Twenty nonuremic patients undergoing abdominal surgery served as the controls. Samples were taken from the parietal peritoneum under standardized conditions and were examined by light microscopy using different staining techniques, semiquantitative grading, and computer-based histomorphometry. RESULTS: A marked loss of mesothelial cells during PD treatment was only observed in cases with two or more preceding episodes of peritonitis, but an increase of the submesothelial fibrous tissue was a common finding and was related to the cumulative glucose load on PD. Patients on PD also had a significantly increased density of small vessels and capillaries in the submesothelial peritoneal layer (12.8 +/- 6.9 per field vs. 6.6 +/- 2.9 in normal controls, P < 0.01). The wall/lumen index of the vessels was increased indicating vascular sclerosis. The degree of vascularization correlated with the amount of fibrous tissue. Patients characterized as high transporters according to the peritoneal equilibration test (PET) had an increased submesothelial fibrous layer. Patients on APD tended to have an increased membrane diameter submesothelial stroma and vascularization (P = NS), although they were treated for a shorter period of time than the CAPD group. Some of the morphologic changes described could already be observed in uremic patients before the onset of dialysis. CONCLUSION: Further research focusing on the clinical and biochemical backgrounds leading to peritoneal membrane changes is of major importance for developing strategies to improve long-term survival on PD.

Adult↗

PubMed2004

Peritoneal dialysis fluid-induced changes of the peritoneal membrane are reversible after peritoneal rest in rats.

BACKGROUND: Peritoneal dialysis (PD) is associated with functional and structural alterations of the peritoneal membrane. However, the (ir)reversibility of these pathological changes of the peritoneum is not understood fully. METHODS: In an experimental PD model, rats (n = 15) received daily 10 ml conventional glucose containing PD fluid, via peritoneal catheters connected to implanted subcutaneous mini vascular access ports. After 5 weeks of treatment, the first group of animals (PDF; n = 10) was sacrificed, while peritoneal catheters of the remaining group of rats (PD-rest; n = 5) were removed 1 week later. The latter group (PD-rest) was sacrificed 12 weeks after removing catheters. At both time points, untreated rats were included as controls. Cellular and morphological parameters were analysed by light and electron microscopy. RESULTS: Rats exposed to PD fluid for 5 weeks showed a severe angiogenesis in various peritoneal tissues. Peritoneal rest resulted in a significant reduction in blood vessel density in visceral (mesentery, P<0.05), but not in parietal peritoneum. Five weeks' exposure to PD fluid resulted in a profound fibrosis in the parietal peritoneum, whereas the degree of fibrosis was significantly reduced in the PD-rest group (P<0.02). Daily exposure to PD fluid induced a higher number of mast cells in the omentum compared with untreated rats, whereas peritoneal rest normalized the increased mast cell density completely (P<0.03). Likewise, continued PD fluid instillation evoked a strong omental milky spot response, which was returned to the control level after peritoneal rest (P<0.009). Furthermore, the number of mesothelial cells on the liver was significantly increased in rats treated with PD fluid, whereas animals from the PD-rest group had a lower number of mesothelial cells, although this was not statistically significant (P = 0.08). Finally, as evidenced by electron microscopy, daily exposure to PD fluid resulted in severe damage to the mesothelial cell layer covering the peritoneum, whereas this cell layer was completely recovered after peritoneal rest. CONCLUSIONS: We show that PD fluid-induced cellular and morphological alterations of the peritoneal membrane are generally reversible.

Animals↗

PubMed2001

The long-term effects of single peritonitis episodes on peritoneal equilibration test results in continuous ambulatory peritoneal dialysis patients.

The present study evaluates the long-term effects of single peritonitis episodes on peritoneal equilibration test (PET) results in continuous ambulatory peritoneal dialysis (CAPD) patients. Twenty-five patients (10 men, 15 women) with a mean age of 37.4 +/- 18.7 years were enrolled in this study because all had uneventful peritoneal dialysis periods for more than one year after a first peritonitis episode. Data from a total of 69 PETs were available [25 from before the first peritonitis episode (initial PET), 23 within 1 year after the episode (1-year PET), and 21 within 1-2 years after the episode (2-year PET)]. The changes in the PET results were evaluated using the dialysate-to-plasma ratio of creatinine (D/PCr) and the dialysate-to-instilled glucose ratio (D4/D0) after a 4-hour dwell. The mean values of D/PCr and D4/D0 showed no statistically significant changes between the initial PETs, 1-year PETs, and 2-year PETs. However, analysis of the results for patients with culture-positive peritonitis (n = 17) revealed significant changes in the mean values of D/PCr and D4/D0 between the initial PET and the 2-year PET (0.63 +/- 0.06 vs 0.70 +/- 0.09, p = 0.01; and 0.41 +/- 0.05 vs 0.37 +/- 0.06, p = 0.04, respectively). The long-term effect of a definite bacterial peritonitis episode seems to be an increase in small-molecule transport. In patients with culture-negative peritonitis, the episode had less impact on peritoneal transport.

Adult↗

PubMed1994

[Determination of peritoneal permeability in chronic peritoneal dialysis using the peritoneal equilibration test].

BACKGROUND: The success of chronic peritoneal dialysis depends among others on the extent of its function as a semipermeable membrane. This so-called functional characteristic can be assessed by several procedures, e.g. by using the so-called peritoneal equilibration test. The objective of the author's investigation was to assemble experience with the method, and based on the results, elaborate an individual therapeutic plan. METHODS AND RESULTS: In 17 patients (8 men, 9 women, mean age when chronic peritoneal dialysis was started 58.4 +/- 11.8 years) the functional capacity of the peritoneum was evaluated using the peritoneal equilibration test (PET). The principle of the test is assessment of the D/P ratio for creatinine and D/Do for glucose (D = concentration of the substance in the dialysate, p = blood concentration of the substance, Do = glucose concentration in the dialysis solution at the time of onset of the test) during four-hour dialysis with 2000 ml solution with a glucose concentration of 2.27% (127 mmol/l). The standardized procedure of the peritoneal equilibration test (12) was modified as regards the calculation of the D/Do ratio: this change simplifies the manipulation with the outlet dialysate and does not affect the result of the test. A total of 22 examinations were made. Based on the results, four patients were included in category H (high peritoneal permeability), 11 into category HA (high average peritoneal permeability) and 2 into category LA (low average permeability). The patients with a higher peritoneal permeability had a lower serum protein concentration (r = -0.63, p < 0.001), and the proteinaemia correlated indirectly with protein losses into the dialysate (r = -0.54, p < 0.01). Intermittent treatment which was prescribed to patients with a high average peritoneal permeability could reduce the total protein losses into the dialysate. CONCLUSIONS: The peritoneal equilibration test is an available method which makes it possible to evaluate the functional properties of the peritoneum.

Adult↗

PubMed1990

Endotoxin-stimulated peritoneal macrophages obtained from continuous ambulatory peritoneal dialysis patients show an increased capacity to release interleukin-1 beta in vitro during infectious peritonitis.

Interleukin-1 (IL-1) release by peritoneal macrophages obtained from patients on continuous ambulatory peritoneal dialysis (CAPD) was studied in nine patients during an infection-free period and eight patients during an infectious peritonitis, using an ELISA for IL-1 beta. Without exogenous stimulation with LPS, peritoneal macrophages from infected and uninfected patients released the same amounts of IL-1 beta, 183 +/- 40 pg ml-1 24 h-1) per 10(6) cells (means +/- SEM) and 251 +/- 96 pg ml-1, respectively. However, in response to a dose of 5 micrograms ml-1 of LPS, peritoneal macrophages released significantly more (P less than 0.005) IL-1 beta during peritonitis (6579 +/- 2793 pg ml-1 24 h-1 per 10(6) cells) compared with the infection-free period (1040 +/- 182 pg ml-1). These findings show that after microbial invasion of the peritoneal cavity, peritoneal macrophages are primed in vivo to release an increased amount of IL-1 beta in vitro after subsequent exogenous stimulation with LPS, indicating that peritoneal macrophage activation for IL-1 beta secretion occurs in steps.

Adult↗

PubMed1994

Gene expression and release of interleukin-8 by peritoneal macrophages and polymorphonuclear leukocytes during peritonitis in uremic patients on continuous ambulatory peritoneal dialysis.

Interleukin-8 (IL-8) has been reported to be released by activated peritoneal macrophages (PMs) and a variety of other cell types, and it exhibits potent chemotactic activity for polymorphonuclear cells (PMNs). We have previously shown that IL-8 is detectable in the drain dialysate of uremic patients on continuous ambulatory peritoneal dialysis (CAPD) during peritonitis. The levels of IL-8 in infected drain dialysate caused by different microorganisms were variable. In this study, we evaluated the gene expression and release of IL-8 by PMs and PMNs during peritonitis caused by Staphylococcus aureus in uremic patients on CAPD. IL-8 levels were variable in the drain dialysate at the different episodes of peritonitis, even in the same patient. The IL-8 levels were highly correlated with PMN count in drain dialysate (r = 0.9919, p < 0.001). PMs and PMNs obtained from drain dialysate at the onset of peritonitis increased mRNA expression for IL-8 and the amount of IL-8 mRNA from drainage cells was also highly correlated with PMN count. In contrast, cells isolated from drain dialysate without peritonitis failed to express mRNA for IL-8. These data suggest that increased expression of IL-8 may be a feature of peritonitis. The levels of IL-8 during peritonitis were not only related to the etiological microorganism but also to other unknown factor(s).

Adult↗

PubMed2002

Peritoneal fluid and solute transport: influence of treatment time, peritoneal dialysis modality, and peritonitis incidence.

The integrity of the peritoneal membrane in peritoneal dialysis (PD) is of major importance for adequate dialysis and fluid balance. However, alterations in peritoneal fluid transport, such as ultrafiltration failure, often develop during long-term PD. To investigate peritoneal solute and fluid transport and to analyze the influence of treatment time, peritonitis incidence, and PD modality (continuous ambulatory PD [CAPD] or automated PD [APD]), a cross-sectional study with an extended peritoneal transport test that used dextran 70 in 2 L of glucose was performed in 23 nonselected chronic PD patients. Compared were long-term (>40 mo) with short-term PD patients (<40 mo), CAPD with APD patients, and those with a peritonitis incidence of >0.25/yr to those with an incidence of <0.25/yr. Dialysate/plasma (D/P) ratio and mass transfer area coefficient of creatinine, lymphatic absorption rate (LAR), transcapillary ultrafiltration, and effective ultrafiltration were measured. Long-term PD patients had higher D/P ratio of creatinine (73.5 +/- 2.3% versus 65.9 +/- 2.2%; P < 0.01) and higher LAR (243 +/- 69 ml/4 h versus 96 +/- 31 ml/4 h; P < 0.03), both resulting in lower effective ultrafiltration (242 +/- 35 ml/4 h versus 324 +/- 30 ml/4 h; P < 0.05). D/P ratio (r = 0.66) and LAR (r = 0.67) were positively correlated to PD duration. Patients on APD compared with those on CAPD and patients with a history of peritonitis compared with those without did not differ in terms of D/P ratio, mass transfer area coefficient, LAR, transcapillary ultrafiltration, and effective ultrafiltration. Lower ultrafiltration after long-term PD is both the result of increased small solute transport and increased lymphatic absorption. APD or CAPD modality and peritonitis incidence do not have a significant influence on small solute transport or fluid kinetics.

Ascitic Fluid↗

PubMed2000

Factors predicting outcome of fungal peritonitis in peritoneal dialysis: analysis of a 9-year experience of fungal peritonitis in a single center.

Fungal peritonitis causes significant morbidity and mortality for patients undergoing continuous ambulatory peritoneal dialysis (CAPD). We retrospectively reviewed 70 episodes of fungal peritonitis in a single center over the last 9 years in 896 CAPD patients. Seventy percent of the episodes of fungal peritonitis were caused by Candida species, among which 50% were Candida parapsilosis. As a result of fungal peritonitis, 44% of the patients died, whereas further peritoneal dialysis failed in 14%, requiring a change to long-term hemodialysis. Only 37% managed to continue CAPD. The remaining 5% either underwent transplantation or were lost to follow-up. We identified the factors associated with poor outcome, namely mortality and technique failure. The presence of abdominal pain, bowel obstruction, and a catheter remaining in situ were significantly associated with greater mortality. Abdominal pain, antibiotic use within 3 months before fungal peritonitis, and complication by bowel obstruction were associated with greater technique failure. In choosing antifungal agents with catheter removal, oral fluconazole alone appears equally as effective as combined oral fluconazole with 5-flucytosine for peritonitis caused by Candida species. For peritonitis caused by species other than Candida, the choice of antifungal therapy needs to be individualized, based on fungal species and sensitivities.

Antifungal Agents↗

PubMed1999

Intermittent versus continuous intraperitoneal glycopeptide/ceftazidime treatment in children with peritoneal dialysis-associated peritonitis. The Mid-European Pediatric Peritoneal Dialysis Study Group (MEPPS).

Intermittent intraperitoneal antibiotic administration appears as a practical and economical therapeutic concept in continuous peritoneal dialysis (CPD)-related peritonitis, but the equivalence of this principle with standard continuous treatment awaits confirmation by prospective, randomized clinical trials. This study evaluates the efficacy, safety, and clinical acceptance of an initial combination treatment including a glycopeptide (vancomycin or teicoplanin) and ceftazidime, each applied either intermittently or continuously, in a cohort of pediatric patients with CPD-related peritonitis. Patients randomized for continuous treatment received an intraperitoneal loading dose of glycopeptide and ceftazidime followed by maintenance doses added to each dialysate bag. In the intermittent treatment groups, the glycopeptide was administered in two loading doses 7 d apart, and ceftazidime during one dialysis cycle per day. Initial treatment response was evaluated after 60 h by the change in a Disease Severity Score and by the clinical decision to continue initial treatment. Of 152 patients observed for a total of 234 patient years, 90 patients developed 195 episodes of peritonitis (including 27 relapses within 4 wk after end of treatment). Dialysate cultures were positive in 83% of the episodes. In gram-positive peritonitis (79% of culture-positive cases), the primary success (overall 95%) and relapse rates (21%) were not different between continuous and intermittent, or between vancomycin and teicoplanin treatment. Oversensitivity reactions occurred in three and ototoxicity in one vancomycin-treated patient, whereas no such side effects were observed with teicoplanin. Residual renal function declined during peritonitis episodes regardless of treatment modality. In gram-negative peritonitis (18% of cases), intermittent ceftazidime treatment was less successful than continuous treatment according to clinical judgment (3 of 11 versus 10 of 14, P < 0.05), but not when rated by Disease Severity Score (8 of 11 versus 12 of 14). In conclusion, intermittent and continuous intraperitoneal treatment of CPD-related peritonitis with glycopeptides and ceftazidime is equally efficacious and safe when measured by objective clinical criteria. This contrasts with a strong tendency of clinicians to move from intermittent to continuous treatment in severe peritonitis.

Adolescent↗

PubMed2004

Longitudinal change in peritoneal membrane function with continuous ambulatory peritoneal dialysis (CAPD) after peritonitis episodes.

BACKGROUND: To assess changes in the peritoneal membrane after peritonitis episodes in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). METHODS: From 1989 to 2002, CAPD patients who had peritonitis episodes were enrolled. We used the peritoneal equilibration test (PET) and measured plasma creatinine (Cr) levels at 2 hours, and dialysate Cr and glucose levels at 0, 2, and 4 hours. In addition, the dialysate-to-plasma ratio of Cr (D/PCr) at 0, 2, and 4 hours, the ratio of glucose levels in the dialysate effluent and infused dialysate ((D/D0)G), the drained ultrafiltration (UF) volume at 4 hours, and the mass transfer area coefficient of Cr (MTAC) normalized for the body surface area were also calculated. D/PCr, (D/D0)G, UF volume, and MTAC were measured at the baseline and after 2 years, and the results were analyzed and compared. RESULTS: Totally 27 patients were enrolled in the peritonitis group, including 17 males and 10 females. They had received CAPD for 71.23 +/- 28.13 months. Forty-nine peritonitis episodes were noted during the study period. Twenty-four patients were enrolled as controls, including 9 males and 15 females. They had undergone CAPD for 55.83 +/- 25.94 months. The baseline and 2-year levels of D/PCr (0.66 +/- 0.11 vs. 0.62 +/- 0.10, p<0.05), (D/D0)G (0.37 +/- 8.45 vs. 0.43 +/- 7.71, p<0.05), and MTAC (9.36 +/- 3.53 vs. 8.08 +/- 3.41, p<0.05) showed significant changes, but UF volume (253.70 +/- 224.43 vs. 311.54 +/- 186.71 ml, p>0.05) showed no significant change. In the control group, there were no significant changes in D/PCr, (D/D0)G, MTAC, or UF volume. CONCLUSION: Peritonitis episodes affect the peritoneal membrane solute transport function in CAPD patients.

Female↗

PubMed1989

Peritoneal functional parameters after five years on continuous ambulatory peritoneal dialysis (CAPD): the effect of late peritonitis.

Functional stability of the peritoneum is essential for patients on long-term continuous ambulatory peritoneal dialysis (CAPD) treatment. Sixteen patients on CAPD treatment for at least 4 years were studied. Their mean age was 47 +/- 15 years, 5 were males, and none were diabetic. Residual creatinine clearance at the beginning was 2.1 +/- 2.6 mL/min. Once yearly since starting CAPD, we have evaluated their peritoneal ultrafiltration (UF) and diffusion capacities by calculating the peritoneal mass transfer coefficient (MTC, mL/min) for urea and creatinine. Patients were categorized so that we could distinguish the effect of peritonitis, betablockers, and hypertension. For all patients the average initial and final MTCs and UF values were not different. Early episodes of peritonitis (those occurring less than 36 months after starting CAPD) did not influence long-term function. However, late peritonitis (occurring greater than 36 months since initiation) induced a decrease in urea-MTC (22.3 +/- 6 to 15.8 +/- 3.9, p less than 0.05), creatinine-MTC (9.4 +/- 3.1 to 7.4 +/- 2.5, p less than 0.05), and a corresponding increase in UF (1.25 +/- 0.4 to 1.4 +/- 0.3, mL/min, p less than 0.05). Age, sex, betablockers and hypertension did not influence the peritoneal parameters followed. After 5 years on CAPD, functional stability of the peritoneum is evident, except for patients who suffer late episodes of peritonitis. We speculate that the peritoneum in patients who have been on long-term CAPD are more susceptible to injuries, such as peritonitis, and that this results in functional deterioration.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

Peritoneal sclerosis in chronic peritoneal dialysis patients: analysis of clinical presentation, risk factors, and peritoneal transport kinetics.

OBJECTIVE: To analyze clinical features of peritoneal sclerosis (PS) in a group of peritoneal dialysis (PD) patients, and to compare potential risk factors and peritoneal transport characteristics with a control group matched for duration of PD. DESIGN: Study 1: Retrospective study of 16 PD patients with PS. Study 2: Case-control study comparing 10 patients with evident PS to 30 control patients who were matched for duration of PD. SETTING: Continuous Ambulatory Peritoneal Dialysis unit in the Academic Medical Centre in Amsterdam. RESULTS: The incidence of PS was 3.5 per 1000 patient years. PS was diagnosed either during PD (n = 10), in patients on hemodialysis (n = 2), or after successful transplantation (n = 4). Presenting symptoms were bowel obstruction, ascites, blood-stained effluent, and impaired net ultrafiltration. Macroscopic confirmation of the diagnosis was possible in 13 patients. Sclerotic encapsulation was present in 8 of them. Patients with PS were divided into three groups based on clinical symptoms and typical macroscopical findings. In category I the diagnosis PS was obvious (10 patients), in category II the diagnosis was highly suggestive (3 patients), and in category III it was doubtful (3 patients). Treatment was conservative in most patients. Surgical treatment was only possible in four and immunosuppressive therapy was given in 5 patients. Peritoneal sclerosis was the direct cause of death in 1 patient. Five patients died during follow-up due to other causes. At present, 7 patients are well and 3 patients (all from category I) still have recurrent bowel obstruction. Compared to matched controls, no difference existed in peritonitis incidence, or in the percentage of patients with former renal transplantations. The number of patients treated with beta-blocking agents and the number of previous abdominal surgeries were not different. The number of catheter-related surgical procedures was higher in the PS patients than in the control group. The mass transfer area coefficient (MTAC) of creatinine was higher in PS patients and net ultrafiltration with 1.36% glucose was lower. The estimated cumulative glucose exposure until the diagnosis of PS was made was larger in PS patients than in their controls. This difference was already present in the first year of PD treatment in 8 of 10 patients. The initial values for the MTAC creatinine were similar in both groups. CONCLUSIONS: The presenting symptoms of PS were bowel obstruction, ascites, and blood-stained effluent, often in combination with loss of net ultrafiltration. Peritoneal sclerosis is a complication of long-duration PD and could also become manifest after a successful renal transplant. Treatment should be conservative unless complications require surgical intervention. Patients with PS had lower net ultrafiltration and higher transport rates compared to controls who were matched for duration of PD. Although peritonitis incidence was similar, a relation of PS with severe peritonitis may be present in some patients. Glucose exposure is likely to be an important risk factor for PS.

Adolescent↗

PubMed1997

[Peritoneal blood flow, peritoneal transfer and continuous ambulatory peritoneal dialysis].

The aim of studies was an evaluation of effective peritoneal blood flow (EPBF) in patients treated with continuous ambulatory peritoneal dialysis (CAPD) and determination if there is a dependence between EPBF, peritoneal transfer and CAPD adequacy. In 14 patients (3 women and 11 men) treated with CAPD through 8.0 +/- 6.1 months the examinations of EPBF using diffusive peritoneal mass transfer coefficient of CO2, CAPD adequacy and peritoneal transfer during the first 2.5 minute dwell of dialysis solution in peritoneal cavity were performed. In 10 patients above mentioned examinations were repeated after 4.7 +/- 0.3 months of CAPD treatment. EPBF after 14 +/- 6.2 months of CAPD treatment showed increasing tendency (460 +/- 250 ml/min) comparing to values obtained at the beginning of treatment (285 +/- 150 ml/min). There was no significant dependence on peritoneal transfer rates of small molecules (sodium, potassium, urea and uric acid) in first 2.5 minutes dwell of dialysis solution in peritoneal cavity on EPBF. At EPBF greater than 200 ml/min excretion of total protein with dialysate and clearances of urea and creatinine showed positive dependence on EPBF. The obtained results indicate that both transperitoneal excretion of total protein and CAPD adequacy are dependent on peritoneal blood flow.

Adult↗

PubMed1990

Comparison of peritoneal white blood cell parameters from continuous ambulatory peritoneal dialysis patients with a high or low incidence of peritonitis.

The purpose of this study was to determine if there were differences in selected dialysate white blood cells (WBC) parameters between continuous ambulatory peritoneal dialysis (CAPD) patient groups identified as having a high or low incidence of peritonitis. Parameters studied were total peritoneal WBC yield, percentage and absolute number of various WBC types, and expression of WBC receptors known to be involved in normal host defense mechanisms. WBCs were obtained from peritoneal dialysis effluents (overnight dwell), which were collected at monthly intervals for 6 to 8 months from eight CAPD patients--four with a history of high peritonitis incidence (HPI) (more than two episodes in 12 months) and four with a history of low peritonitis incidence (LPI) (no episodes in more than 24 months). Our results demonstrated that there was no significant difference in the overall mean total cell yields or absolute cell counts between the two patient groups. WBC differentials, although differing somewhat among patients, stayed quite stable over time for an individual patient and there was no significant difference between the two patient groups. Analysis of receptors on the peritoneal WBC was performed using flow cytometry and fluorescein-conjugated chemotactic factors (C5a and fMet-Leu-Phe-Lys), as well as monoclonal antibodies specific for Fc receptors and complement receptors, CR1 (CD35) and CR3 (CD11b). Although there was a trend toward increased expression of all these receptors in the HPI patients, there was no significant difference in the fluorescence intensity of peritoneal neutrophils or macrophages that expressed these receptors between the two patient groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2000

Use of bolus intraperitoneal aminoglycosides for treating peritonitis in end-stage renal disease patients receiving continuous ambulatory peritoneal dialysis and continuous cycling peritoneal dialysis.

Peritonitis is the most common complication of peritoneal dialysis (PD) and accounts for the most drop-out from PD among patients with end-stage renal disease (ESRD). Antibiotic protocols to treat peritonitis recommend initial treatment for both gram-positive and gram-negative infections, pending culture results. Current literature also suggests comparable therapeutic success using bolus (single-dose) parenteral aminoglycosides to treat systemic gram-negative infections compared to conventional divided-dose aminoglycosides. The single bolus dose antibiotic regimen has the potential for reduced nephrotoxicity and ototoxicity. We therefore hypothesized that intermittent bolus dose intraperitoneal (i.p.) aminoglycosides may be superior to conventional continuous dose i.p. aminoglycosides in treating dialysis-associated peritonitis, and have fewer side effects. Six patients with clinical peritonitis were treated with single, bolus-dose, i.p. gentamicin or tobramycin (5 mg/kg ideal body weight), range 250-440 mg (mean: 355 +/- 68.25 mg) at the start of therapy. No patient grew gram-negative organisms; aminoglycosides were therefore not repeated. Three patients used four continuous ambulatory peritoneal dialysis (CAPD) exchanges per day; three patients used six nightly continuous cycling peritoneal dialysis (CCPD) exchanges with a daytime dwell. Mean PD aminoglycoside clearance was 6.75 +/- 2.27 mm3/min; mean urinary aminoglycoside clearance was 5.75 +/- 1.14 mm3/min. Mean blood aminoglycoside elimination t1/2 was 29.27 +/- 3.55 hours, with a mean blood level of 3.18 +/- 1.45 micrograms/mL 72 hours after initial therapy, and 1.52 +/- 0.81 micrograms/mL 96 hours after initial therapy. Peritoneal equilibration test (PET) scores before and after aminoglycoside administration (performed a mean of 4.6 months apart) were 0.672 +/- 0.097 and 0.705 +/- 0.092 respectively (p = 0.321). Comparative audiograms using pure-air tone conduction with frequencies from 250-12,000 Hz were done within 24 hours of aminoglycosides and again when therapy was complete (mean: 17 days). No significant changes were seen. While efficacy of bolus versus conventional-use aminoglycosides could not be definitely established, the kinetics of bolus aminoglycosides suggests that therapeutic blood levels persist for 72-96 hours and that the risk for oto/vestibular toxicity is negligible. We conclude that use of bolus i.p. aminoglycosides is safe, achieves therapeutic blood levels for extended intervals, demonstrates no clinical oto/vestibular toxicity, is cost-effective, and is a convenient strategy for patients and nursing staff.

Anti-Bacterial Agents↗